Use of oral anticoagulants in complex clinical situations with atrial fibrillation.

Use of oral anticoagulants in complex clinical situations with atrial fibrillation. Med Clin (Barc). 2018 Jun;150 Suppl 1:8-24 Authors: Gullón A, Sánchez Fuentes D, López-de-Sá E, Martí-Almor J, Barón-Esquivias G, Jiménez López J, Del Mar Contreras Muruaga M, Suárez Fernández C Abstract The present article provides an update on anticoagulant treatment in patients with atrial fibrillation in distinct clinical scenarios requiring particular considerations, such as ischaemic heart disease, electrical cardioversion, pulmonary vein ablation, the presence of valvular disease with or without prosthetic valves, and renal insufficiency, as well as old age and frailty. In patients with non-valvular atrial fibrillation, the presence of renal insufficiency increases both thrombotic and haemorrhagic risk. In mild and moderate stages, direct-acting anticoagulants confer a greater benefit than warfarin, although they usually require dose adjustment. In renal failure/dialysis, there is no solid evidence that warfarin is beneficial and the use of direct-acting anticoagulants is not recommended. Because of its pathophysiology, oral anticoagulation could have a beneficial effect in patients with heart disease. However, vitamin K antagonists have not shown a satisfactory risk-benefit ratio. In contrast, direct-acting anticoagulants, at reduced doses, could have a beneficial effect in this scenario in association with antiplatelet agents. The u...
Source: Medicina Clinica - Category: General Medicine Tags: Med Clin (Barc) Source Type: research